Statewide Tools for Hospital and Health Services to achieve Standard 10:

Preventing Falls and Harm from Falls Kate Crowley Smith

Thursday 13th June 2013

Patient Safety Unit

• Falls Injury Prevention Collaborative Steering Committee members

• The Stay On Your Feet® Team • Patient Safety Unit staff – Measurement,

Reporting and Analysis Team, PRIME, Productive Ward Team

Acknowledgements

Patient Safety Unit Role• Patient Safety Unit’s (PSU) role is to

provide support services to Hospital and Health Services (HHSs) and the Department of Health to maximise patient safety outcomes and the experience of Queensland public health system patients

Key prioritiesPSU’s 3 key priorities include:

1. Standards implementation support

• support HHSs to meet National Safety and Quality Health Service Standards (NSQHSSs)

• develop and sustain practical, cost effective patient safety improvement tools.

How PSU helps HHS meet standard 10. Overview of methods: 1. Support – Collaboratives, Working Groups and

Networks 2. Tools - audit, assessment and screening,

policies, brochures, on-line education3. Ease of access – toolkit, website4. Statewide Audit – QBA, 5. Reports – QBA report, Standard Report

10.1 Policies, procedures, protocols

Preventing falls and Harm from Falls Policy

http://www.health.qld.gov.au/psq/falls/docs/falls-model-policy.doc

10.1 Policies, procedures, protocols

Implementation Standard for Preventing falls and Harm from Falls

http://www.health.qld.gov.au/psq/falls/docs/falls-model-impl.doc

10.1.2 Policies, procedures, protocolsKey tasks:• Identify an individual or group responsible for

monitoring the use of policies, protocols and procedures for preventing falls and harm from falls

• Develop evaluation processes for the use of falls prevention and management policies, procedures and protocols across the organisation

Support – Collaboratives, Working Groups and Networks

Falls Injury Prevention Collaborative Steering Committee

Support : 1. Chairs of Falls Working

Group - 2nd monthly meetings2. Quality and Standards

Network meeting - monthly meetings

3. Productive Ward –Releasing Time to Care-monthly meetings

4. Adhoc specific working groups

Audit Tools for the Standardshttp://www.health.qld.gov.au/psq/safetyandquality/n sqhss-audit-tools.asp

http://www.health.qld.gov.au/psq/safetyandquality/d ocs/falls-audit-facility.pdf

Audit Tools for the Standards• Facility audit tool:

http://www.health.qld.gov.au/psq/safetyandquality/docs/falls-audit-facility.pdf

• Ward/Unit audit tool: http://www.health.qld.gov.au/psq/safetyandquality/docs/falls-audit-ward.pdf

• Patient audit tool: http://www.health.qld.gov.au/psq/safetyandquality/docs/falls-audit-patient.pdf

• Measurement Plan : http://www.health.qld.gov.au/psq/safetyandquality/docs/falls-measure-plan.pdf

10.2 Robust reporting and change management …

Methods for reporting: 1. HHS Service Agreements2. Standard Reports3. PRIME – clinical incident and complaints

system, 4. Nurse Sensitive Indicators - draws on

PRIME & other data 5. Queensland Bedside Audit

1. HHS Agreements

Service Agreement (remains in effect until 30 June)http://www.health.qld.gov.au/hhsserviceagreement/docs/monitoringkpis.pdf

2. Extract from Standard Report

• Reports are based on incident data

• Standard report using crystal reporting

• Falls detail for the facility

• Falls summary for facilities and HHS

• These are configurable reports

• 6 monthly release

3. PRIME• PRIME is the incident reporting system • Collect fields such as:

– type of Fall as reported by the patient e.g. dizzy, legs gave way – Select the activity at time of fall e.g. sit to stand – Select the function being attempted by the patient at the time of fall

e.g. showering, dressing – Witnessed or unwitnessed – Select post fall management actions e.g. reassessment– Select factors may have contributed e.g. communication

• Developing configurable reports for HHS

4. Nurse Sensitive Indicators • NSI draws information from PRIME and other data sources

such as sick leave, staffing, skills mix, agency use • State wide dashboard, monthly dashboard, peer comparison • Presents a traffic light report • Falls - reported clinical incidents

– Total Reported falls per 1000 Accrued Patient Days – Total Reported Injury Falls per1000 Accrued Patient Days – Reported Assisted Falls with Injury per 1000 Accrued Patient Days – Reports Falls SAC1 per 1000 Accrued Patient Days – Reports Falls SAC2 per 1000 Accrued Patient Days – Reports Falls SAC3 per 1000 Accrued Patient Days – Reported Repeat Falls per 1000 Accrued Patient Days – % of Reported Falls with a Completed Risk Assessment

The QBA collects data for reporting on elements of the NationalSafety and Quality Health Service (NSQHS) Standards andother key safety and quality areas that are not systematicallycollected such as:• Patient Experience• Medication Safety• Malnutrition Prevention• Recognition and Management of the Deteriorating Patient

• Falls Prevention• Patient Identification• Pressure Injury Prevention.

5. Overview : Queensland Bedside Audit

• The Queensland Bedside Audit (QBA) is an annual bedside audit undertaken in Hospital and Health Services (HHS) within Queensland.

• 119 facilities and 22 RACF 2012 QBAs were conducted in 17 HHSs in November 2012, over one or more days, on dates that differed between facilities.

• Planning and preparation is underway for the 2013 QBA. The 2013 QBA will be undertaken in October 2013.

Queensland Bedside Audit

Audit Process

• Data is collected via scannable forms - in booklet format to use for each bed audited.

Or• Entered and validated directly

at the bedside via an iPad or Computer on Wheels. (MARS: Measurement Analysis and Reporting System)

Data Collection

Audit tool• Questions are designed

around the actions in the standards

• Form is specially designed to minimise data entry to allow accelerated data collection

• Form is intuitive with Tips and Instructions to guide the auditor to the next question

QBA Falls audit questions

Section 10 Falls

Falls indicators link to NSQHS Standard actions

Resources provided to HHSs

Audit Tools •http://www.health.qld.gov.au/psq/safetyandquality/nsqhss-audit-tools.asp

Electronic collection

Measurement Analysis and Reporting System (MARS)

Developed by Opus 5Khttp://www.opus5k.com.au/form_builder.html

The Queensland Department of Health is developing the current paper tools in an electronic data collection system to allow HHSs the ability to collect, validate, collate and report results at the local level…

QBA Reporting

A number of QBA reports are provided to HHSs to allow for benchmarking across wards, facilities, health services, peer groups and at a statewide level.

10.2.4 Action is taken to reduce frequency and severity of falls …Key tasks :• Develop education and orientation

resources and programs for the workforce management points at risk of falling

• Use data from the monitoring system to develop or review improvement strategies and action these at individual

(Standard 10 Safety and Quality Improvement Guide page 13)

iLearn@health.qld.gov.au

10.3 Undertaking quality improvement activities

• Productive Ward – Releasing Time to Care

• http://www.health.qld.gov.au/psq/html/productive_homepage.asp

Falls Module

Pressure Injury Module

10.5 Best practice screening assessment tools

10.5 Best practice screening, Ax tools

Calls to actionTo prevent patient falls, staff are encouraged to:• complete a falls risk assessment• educate patients on how to prevent falls• develop a falls prevention plan with your patients• complete the Falls Preventing Falls and Harm from Falls online education at:

https://ilearn.health.qld.gov.au/login/index.php

10.6 Comprehensive assessment

10.6.2 Review Patient Clinical RecordsSection 10 Falls QBA

Falls indicators link to NSQHS Standard actions

10.7 Developing and implementing a multifactorial f alls prevention plan to address risks identified in the assessment

10.8 Patients at risk of falling are referred to ap propriate services, where available, as part of the discharge process

Falls Assessment and Management Plan

Patient Audit Tool

10.9 Informing patients and carer about the risk of falls, and falls prevention strategies

10.10 Developing falls prevention plans in partnership with patients and carers

Gaps• Falls alert sign • Other languages• Emergency Department • Action plans against the data • Children’s Health Services• Speciality areas e.g. Day Unit areas,

Oncology

Questions

PSU contact details:

• stayonyourfeet@health.qld.gov.au• Kate Smith • 07 3646 9891http://www.health.qld.gov.au/psq/falls/default

.asp